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Death In New York City

Â Many New Yorkers think of their city as tough, rough, and a tad more perilous than most; a place where armed muggers lurk in ambush, bike messengers and speeding cabbies mow down pedestrians, air conditioners and giant chunks of ice occasionally fall from high buildings to sidewalks below, peeling lead paint tempts infants, and the air quality downtown is more suspect than ever.

But while the city certainly presents some hazards to life and limb, the health department's annual report on registered deaths and causes of death, as well as other vital data, actually reveals that the number of deaths in the city reached a historic low in 2002, infant mortality rates were also at an all-time low, and the life expectancies of New Yorkers were longer than ever before â€“ longer, in fact, than the national average.

The city's Department of Health and Mental Hygiene released the 67-page report, the Summary of Vital Statistics for 2002 (available in pdf format), on January 30. The year 2002 is the most recent for which data was compiled and analyzed; because the annual report is a formidable undertaking, it tends to lag a year or two behind the year of its release.

2002 saw 59,651 deaths recorded in the city, down from 62,964 in 2001. If not for the 2,746 deaths from the World Trade Center disaster, 2001 would have set the previous record for lowest number of deaths in the city. And even if one excludes the World Trade Center deaths from the 2001 total, there was still a decline in deaths of about one percent from 2001 to 2002, continuing a trend that started in the 1990s.

Infant Mortality at All-time Low

One factor driving the decline in the city's death rate was that infant mortality in the city reached an all-time low in 2002, at six infant deaths for every 1,000 live births. As recently as 1990, the infant mortality rate had been twice that high. The New York City rate was also lower than the national average in 2000 (the most recent year national data was available), which was 6.9 deaths per 1,000 births.

But since the report breaks down the city's deaths by ethnicity and location as well as age, cause, and gender, it also makes it clear that infant mortality varies dramatically among ethnic groups and neighborhoods. As the health department notes in a separate statement about the 2002 infant mortality numbers, the infant mortality rate is a critical indicator of a given community's social welfare. It reflects the health of the mothers before, during, and even after pregnancy, as well as the accessibility and quality of local healthcare services. Among the factors that the health department cites as influencing infant mortality rates are the mother's access to prenatal care and the quality of such care; her overall health; her socio-economic status; her stress level during pregnancy; her use of alcohol, tobacco, and other drugs during pregnancy; and the infant's birth weight (which can be affected by all of the preceding). It is unsurprising though grim news that babies born in the Brownsville section of Brooklyn have infant mortality rates of 10.3 per 1,000 births, 50 percent higher than the city average; or that black babies are more likely to die than white.

Dr. Thomas Frieden, the health department's commissioner, emphasized the need for more to be done to eradicate these variances in infant mortality among different ethnicities and geographic locations around the city. “Six-point-zero is the lowest rate ever in the city's history, and continues a longterm trend of declining infant mortality rates in New York City," Frieden said. "However, unacceptably high disparities persist in some communities. We will address these disparities by targeting resources to those communities in greatest need and connecting at-risk women to available services.”

New Yorkers Living Longer

Not only have death rates declined, but New Yorkers' life expectancy has increased markedly over the past decade. Average life expectancies are the highest in New York City's history, and for the first time in 60 years New Yorkers are living longer than other Americans (77.6 years in New York vs. 77 years nationally). The life expectancy for girls born in the city in 2000 is 80.2 years, an increase of 3.2 years from 1990. Life expectancy for boys born in the city in 2000 is 74.5 years, a dramatic increase of almost seven years from 1990, when a newborn boy could on average expect to live only 67.7 years. The report indicates that this lengthening of New Yorkers' life expectancies is mostly due to the decline in the number of deaths from HIV/AIDS and homicide (2,300 combined in 2002, a quarter of what they were in certain years over the last decade). The marked decline in infant mortality is also a factor.

But Much Room for Improvement

Large and troubling disparities exist among different ethnic groups in life expectancy also. The average male African-American in New York can expect to die almost six years younger than a (non-Hispanic) white male. Black women's life expectancy is 3.7 years shorter than white women's. There has been a narrowing of these gaps in the past decade â€“ in 1990, the difference in life expectancy between black and white males in New York was an appalling ten years (60 years for blacks vs. 70 for whites). Among women, the black-white gap a decade ago was 5.7 years. Happily, the life expectancies of all three of the racial groups tracked â€“ Hispanic, non-Hispanic white, and black-- have lengthened; African-American New Yorkers' have increased the most, which is why the gap has narrowed. Between 1990 and 2001, black men's life expectancy increased by nine years and black women's by five years; whites' increased too, but by half as much -- five years for men and 2.5 years for women.

While acknowledging the narrowing of the gaps as progress, health department commissioner Frieden nonetheless called the remaining disparities "unacceptable." Indeed, despite the record-breaking lows represented by the latest citywide mortality figures, Frieden emphasized the need for future improvements as much as he did the progress that has taken place.

“More than eighteen thousand New Yorkers died [in 2002] before they reached age sixty-five," he said. "Most of these deaths were preventable." More than half of the under-65 deaths were due to only three causes -- cancer, heart disease, and HIV/AIDS â€“ all of which Frieden considers preventable, at least in that age group. "Nearly one out of six New Yorkers who died was killed by tobacco," he added. Tobacco use was implicated in many of the cancer and heart disease deaths; for example, nearly 20 percent of the cancer deaths were from lung cancer, and as much as 90 percent of lung cancer has been shown to result from tobacco use.

What New Yorkers Died of in 2002

The morbid or the merely curious can learn from the report that the five leading causes of death for New Yorkers, factoring in all age groups, were the same in 2002 as in 2001 â€“heart disease, cancer, flu/pneumonia, stroke, and HIV/AIDS, in descending order. For the sub-group of New Yorkers who died before age 65, the five leading causes of death were cancer (most commonly lung cancer, which accounted for more than twice as many deaths as the next two most common fatal cancers, breast and colon); heart disease; HIV/AIDS; psychoactive substances (either by overdose/poisoning or cumulative, long-term health damage); and finally accidents, including car accidents, falls, accidental poisonings (other than by drugs and alcohol), and other fatal mishaps.

They might also be interested to know that the prevalence of the causes of deaths differed by gender. Cancer was clearly the biggest killer of women who died before 65, accounting for slightly more than a third of these deaths; while heart disease tied with cancer for the leading cause of death of men under 65, each killing 22 percent of the total.

And the fact that the third leading cause of death among city residents, especially those over age 75, is the flu may come as a surprise to the many New Yorkers who think of it as just another of winter's commonplace ordeals, unpleasant but not especially dangerous. Flu can quickly prove deadly, however, if it progresses into a more serious illness such as pneumonia. Those obsessing about West Nile Virus (which caused a total of three fatalities in 2002) and Lyme Disease-carrying ticks in the Hamptons would do better to get an annual flu shot than to waste more time worrying about exotic but rare and/or less lethal diseases.

No New Yorker, by the way, had died of mad cow disease as of 2002.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF

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